| Square Medical Group Llc | |
|
124 Watertown St Suite 2d Watertown MA 02472-2576 | |
| (617) 916-5069 | |
| (617) 467-4073 |
| Full Name | Square Medical Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 Watertown St, Watertown, Massachusetts |
| Authorized Official Name and Position | Natalie Leonid Lender (MEDICAL DIRECTOR, OWNER) |
| Authorized Official Contact | 6179165069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Square Medical Group Llc 124 Watertown St Suite 2d Watertown MA 02472-2576 Ph: (617) 916-5069 | Square Medical Group Llc 124 Watertown St Suite 2d Watertown MA 02472-2576 Ph: (617) 916-5069 |
| NPI Number | 1356515464 |
|---|---|
| Provider Enumeration Date | 04/18/2008 |
| Last Update Date | 08/13/2015 |
| Medicare PECOS PAC ID | 6608991187 |
|---|---|
| Medicare Enrollment ID | O20100921000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356515464 | NPI | - | NPPES |
| 3173615 | Medicaid | MA |
| Provider Name | Erich Goetzel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891834388 PECOS PAC ID: 5092629816 Enrollment ID: I20031117000412 |
| Provider Name | Alexander Kozlovsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679531297 PECOS PAC ID: 5496738205 Enrollment ID: I20040611000874 |
| Provider Name | Natalie Lender |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740371038 PECOS PAC ID: 2466423280 Enrollment ID: I20040804001538 |
| Provider Name | Miles G Cunningham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922014331 PECOS PAC ID: 2062488612 Enrollment ID: I20040907000185 |
| Provider Name | Cynthia Susan Carter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871695072 PECOS PAC ID: 8123070463 Enrollment ID: I20050215000962 |
| Provider Name | Kenneth J Adelman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497700694 PECOS PAC ID: 9032164918 Enrollment ID: I20050314000597 |
| Provider Name | Patricia B Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659406791 PECOS PAC ID: 0446269195 Enrollment ID: I20060407000593 |
| Provider Name | Grigoriy I Labun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144252685 PECOS PAC ID: 8325042864 Enrollment ID: I20060914000235 |
| Provider Name | Alan Fisch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043239270 PECOS PAC ID: 9931108883 Enrollment ID: I20061204000398 |
| Provider Name | Marlyn Jules |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184947772 PECOS PAC ID: 3577693761 Enrollment ID: I20100615000335 |
| Provider Name | Anna M Coulstring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336457191 PECOS PAC ID: 9133308265 Enrollment ID: I20110121000418 |
| Provider Name | Linda L Lesage |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1568433894 PECOS PAC ID: 6002070372 Enrollment ID: I20120618000365 |
| Provider Name | Kimberly S Quinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336499532 PECOS PAC ID: 5698927531 Enrollment ID: I20121128000753 |
| Provider Name | Andrea Hutcheson Warden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841623220 PECOS PAC ID: 8123240959 Enrollment ID: I20141112000592 |
| Provider Name | Katherine S Gorham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124282470 PECOS PAC ID: 3072826254 Enrollment ID: I20150716002124 |
| Provider Name | Katherine Elizabeth Wolcott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013355189 PECOS PAC ID: 0547401127 Enrollment ID: I20160222000945 |
| Provider Name | Susan W Stern |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154443224 PECOS PAC ID: 6709147507 Enrollment ID: I20180219000071 |
| Provider Name | Sean Martin Markey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699078295 PECOS PAC ID: 2961750302 Enrollment ID: I20180801002786 |
| Provider Name | Robyn Elizabeth Kinsherf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043878234 PECOS PAC ID: 3476884313 Enrollment ID: I20191008002123 |
| Provider Name | Megan Macleod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770057283 PECOS PAC ID: 7113259680 Enrollment ID: I20191101002028 |
| Provider Name | Debra Louise Booth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043846942 PECOS PAC ID: 1658769344 Enrollment ID: I20211029000831 |
| Provider Name | Jamaal C Hedrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639677917 PECOS PAC ID: 4981010733 Enrollment ID: I20220721000329 |
| Provider Name | Vincent Sullo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306398565 PECOS PAC ID: 6709261134 Enrollment ID: I20220920003775 |
| Provider Name | Tanya Gershman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982321055 PECOS PAC ID: 0244601946 Enrollment ID: I20230117000635 |
| Provider Name | Kathryn Sutherland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578290938 PECOS PAC ID: 1052775855 Enrollment ID: I20230913000105 |
| Provider Name | Martin Innis Frazee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548824089 PECOS PAC ID: 3678920543 Enrollment ID: I20240226000027 |
| Provider Name | Lauryn Hebert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376943746 PECOS PAC ID: 3678882404 Enrollment ID: I20240420000124 |
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